Oropharynx - SCC of the Palatine Tonsil
HIDEInteractive Transcript
0:01
Hello everyone,
0:02
Dr. Sidney Levy here.
0:03
Today I would like to continue our discussion of diagnosis
0:08
and staging of oropharyngeal squamous cell malignancy.
0:11
I would like to focus on the palatine tonsils.
0:15
These are the most common site of oropharyngeal
0:19
squamous cell malignancy, constituting
0:21
between 70% to 80% of identified tumors.
0:25
I have some pre-contrast T1-weighted
0:27
imaging without fat suppression on the left.
0:31
T2-weighted imaging with fat suppression in the
0:34
middle and post-contrast T1-weighted imaging with fat
0:38
suppression on the right in the axial and sagittal planes.
0:44
So, palatine tonsil tumors may be clinically occult
0:49
or very difficult to identify, if at all, on imaging.
0:55
And sometimes the only way that they are
0:57
discovered is secondarily after a nodal metastasis
1:01
is identified within the ipsilateral neck.
1:07
In this case though, I will use a larger tumor
1:09
to help demonstrate the imaging features.
1:13
The first thing I'd like to do is to draw the tumor for you.
1:18
So, on T1-weighted imaging,
1:21
the tumor is often slightly hypointense or isointense
1:23
25 00:01:27,090 --> 00:01:29,090 to normal tonsillar tissue.
1:29
You can always look at the opposite
1:30
side for normal tonsillar tissue.
1:33
So, here's the normal left tonsil.
1:36
Here is the abnormal right tonsil with the tumor.
1:43
In this case, it's isointense.
1:47
On T2-weighted imaging, it is
1:49
mildly to moderately hyperintense.
1:52
On post-contrast imaging, it is usually hyper-
1:56
enhancing, but in this particular case, not so much.
2:00
So this is a bit atypical,
2:02
but here is the outline of the tumor.
2:04
The morphology of the tumors may be ulcerative,
2:08
infiltrative, or exophytic if large.
2:12
Because this is a large tumor, it has taken on a
2:15
combination of exophytic and ulcerative properties.
2:20
The big clues are to look for asymmetric enlargement of
2:23
the palatine tonsil and a blurring of the deep margin.
2:28
So, in this case, if you look at the normal tonsil,
2:31
you can see that there is a fat plane between the
2:34
normal tonsil and adjacent soft tissue, just here.
2:40
So we've got some fat in here,
2:42
which helps to provide a delineation.
2:46
On the right-hand side, this is all lost.
2:49
So, we can say that there is an invasive
2:51
deep margin of this tonsillar tumor.
2:54
The last thing to remember is that the location of
2:58
these tumors is usually within the tonsillar fossa,
3:01
as opposed to the anterior or posterior tonsillar pillars.
3:05
In our next vignette, we will discuss the patterns
3:08
of spread and nodal drainage of these tumors.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
© 2025 Medality. All Rights Reserved.